Hi, welcome to this portion of our
video series on electrocardiograms.
In this one, we're going to talk
about how you treat sinus tachycardia.
Now I'm really tempted to talk very
quickly because this is super fast rhythm.
However, I'm going to slow down so
you can understand what I'm saying.
Now speaking of slowing down, when
you look at normal sinus rhythm,
the difference between normal sinus rhythm
and sinus tachycardia is simply the rate.
Normal sinus rhythm is 60 to 100, and then you
have for sinus tachycardia greater than 100.
So in normal sinus rhythm, you guys
know that we have a normal P wave
before every QRS complex,
The rhythm is regular, but it
can vary during respirations.
The P wave is positive.
That means if you look at the isoelectric
line, it is above the isoelectric line
and it's positive in leads I, lead II and
you'll also see it be biphasic in lead V1.
Remember the range of normal
sinus rhythm is 60 to 100.
Now, Let's speed this up, because
sinus tachycardia is faster.
The heart rate is greater than
100, the rhythm is still regular,
you have a P wave before every
QRS, they all look the same.
The PR interval is normal, and the QRS is normal.
Now let's talk about the
causes of sinus tachycardia.
I feel like we're in therapy because some of the
causes of tachycardia are what we all live on.
If you're in school for any program, you
probably are drinking way too much caffeine.
So keep that in mind.
That is a cause of sinus tachycardia
and you will feel your heart rate just
Now, some people are really sensitive to
caffeine, other people can kick it back
without much impact, but keep in mind if
you're feeling your heart rate be elevated,
caffeine is likely a culprit.
Now other things include alcohol,
nicotine, stimulant drugs,
like your friend cocaine and methamphetamine.
No, I'm just kidding.
They are not your friend, but any
stimulant drug will elevate your heart rate
and can put you in an increased
risk for sinus tachycardia.
Pain. That's a big one as a nurse.
If a patient is in pain, if you notice
that their heart rate is elevated,
and you ask them how they're feeling,
and they're like, 'I'm fine',
but their heart rate is really elevated,
you're gonna want to ask some more questions.
That's also another way that
we can monitor a patient
who for some reason can't
speak to us or isn't awake.
If we noticed their heart rate going up, we
need to follow up and see what the problem is.
Now an underactive thyroid or
hypothyroidism can cause sinus brady.
So it makes sense that an overactive thyroid
or hyperthyroidism can cause tachycardia.
Other things include fever,
anxiety, anemia, and hypovolemia.
Okay, now, you know, I just
like to give you a list.
Let's tell you the "whys" behind these.
Caffeine, alcohol, nicotine, we're mostly familiar
with those and stimulant drugs that makes sense.
When you hurt, you know, you don't
feel calm when you feel pain.
That should make sense why
your heart rate goes up.
Thyroid, hey, everybody wants a
little bit of an overactive thyroid
so we could eat what we want
without any consequence,
but with extra thyroid hormone in your
body, it's going to stimulate everything.
You're going to be warmer, and that
heart rate is going to be faster.
Fever, oh, that's really tough on the body.
It is amazing what a fever can do.
In fact, it's the body's way of you know,
killing things that shouldn't be living in there.
So sometimes fever serves a really good purpose.
But along with that extra elevation in temperature,
you'll have an elevation in heart rate.
Anxiety, hmm, you get that feeling in
your stomach and you feel really anxious,
you start to breathe faster, like I don't
know, right before or during a Nursing exam?
That's what can cause a sinus tachycardia.
When the anxiety is relieved, we should be
able to bring that back down to more normal.
That one is really interesting.
So think about it.
First of all, what is anemia?
Well, it is low red blood cells.
What do red blood cells do?
Well, they're literally just sacks
that carry four hemoglobins, right?
Well, infants have a little more but adults
have four hemoglobin carriers, right?
And hemoglobin is what carries the oxygen.
So that's all a red blood cell does.
If I don't have enough red blood cells,
uh oh, my body is not getting oxygenated.
It's not delivering, it's not being perfused
because oxygen is not being delivered
to my tissues.
So how does the body compensate?
The heart beats faster, trying to help you
stay on top of things and get more delivery.
So you have fewer red blood
cells, so your body amazing,
just moves the fewer red blood
cells you have around faster.
That's how anemia works, will
cause possible sinus tachycardia.
So consider each one of these causes
as you're thinking it through.
Now we save the biggest one for last.
This seems to come up on exams all the time.
If someone is in hypovolemia, it's part of
their blood, right Because we have -emia,
but it says hypo- meaning low volume.
Okay, now when I have low
volume in my circulatory system,
what impact will that have on my blood pressure?
My blood pressure will be lower.
My body and my brain knows, if
I have too low a blood pressure,
I'm not going to be able to
again perfuse all my tissues.
So if somebody is low on volume,
how does the body fix it?
It vasoconstricts, and it elevates
the heart rate to keep you alive.
So if you have a patient, or a test
question, where the patient's vitals,
have a blood pressure that drops below
100, and a heart rate that's above 100,
and let's say they've recently had
surgery, or they're at risk for bleeding,
or being incredibly dehydrated,
think about hypovolemia
as the cause of the sinus tachycardia.
Okay, now that is quite a list.
So you know, your job is, pause the video, think
about how you can group those things together
so it makes sense in your mind,
what the causes are of tachycardia.
So pause it, take a minute and
then come back and rejoin us.
Okay, welcome back.
But with this many causes, gosh,
how are we going to fix all this?
How do we fix sinus tachycardia?
Well, the answer is, we have to resolve the
underlying cause of the elevated heart rate.
So let's go back through
that list for just a second.
So caffeine, we're going to need
you to slow down on the caffeine
but be very careful.
If you've been taking significantly
large amounts of caffeine,
don't just stop cold turkey, you
will wish you hadn't, you'll have
the worst headache and even possibly
go through a type of depression.
So we wean that down.
Alcohol, same thing wean that down.
Nicotine, wow if you've ever smoked, you know
that that's a really difficult habit to stop,
especially if you're smoking or vaping,
it's going to be a real challenge.
So get some help in kicking that one.
Cocaine and meth, we're just going to pretty much
recommend here at Lecturio that you don't do those.
But if you're on other prescribed stimulants, you
also need to watch your heart rate pretty closely
Pain, we're going to relieve it.
Overactive thyroid, we're going to give you a
medication that will deal with that extra thyroid.
Fever. We're going to let you go
a little bit to see if it needs to
fry that bug but we're going to keep a close
eye on it So it doesn't overstress your body
Anxiety, we're going to treat
the underlying cause of that.
Consider medication and therapy
because that is miserable for patients.
Anemia, we got to figure out what
type of anemia it is so we can fix it.
Hypovolemia, we're going to give you some fluids
and we may even need to give
you some blood products.
So sinus tachycardia treatment
involves identifying what the cause is,
and resolving that.
Before you can fix the underlying cause, as a
nurse, you need to be at the top of your game
to identify what is the underlying cause.
Well, how do I do that?
Well, you can ask questions of the
patient, process of elimination,
you need to know all the things
that could cause sinus tachycardia
and then see if those are
appropriate for your patient.
Now in Sinus tach, the electrical impulses
are conducting appropriately through the heart
but are firing at an elevated
rate of greater than 100 a minute.
Thank you for watching our video today.